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I APPLICATION FOR SANITATION PERMIT Permit No. ------la_--_,�� _ (Complete in Duplicate) Date Issued .--_-_ Applic 4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND L .CATION . ---•-- � ------ -- -J`•-----------=-•---.............. Owner's Name._... . ---- . .. '. •--•--------- - --- ------ --- --- ------------------------------ Phone..................-....... ........._ t _ _ -- -- ---- Address--- 5_'��---------- - =-.. ................ / Contractor's Name..---,[1+-�z---- .... �U ------` :. .fl1 .................. Phone. 6 a Installation will serve: "Residenc e Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: _I____ Number of bedrooms _ -Number of baths ....1_ Lot size ------ .................... s� ._, _./_QJO.................... Wafer Supply': 'Public system 5L Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe jj Hardpan ❑ Previous Application Made: Yes•❑ No L& New Construction: Yes ❑ No 0, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tanVor-cesspool permitted if public sewer is available within 200 feet.) ; Septic Tan`J'�", omrom nearest well :Distance from foundation Material ❑ No. of partments................. 'Size------•---•................—Liquid depth.•------------------------Capacity...................... Disposal Field; Disfiance from nearest well__ 4:hr—Distance from foundation_...f-0 . ._..Distance to nearest lot line_f�0..... wNu'mbe_r,�o.f_. lines...... length hl �jWidth of french.___....: �-' matenaL._•.. ----- -•-----,• - � Type of'filferiDePhoflterml`ateTotal ; ._ ff .Pvundaion._._ _.. ist nvto nearest lot line____Pit: 'Distan'c'e to e_ares+ ell Qstance rom$eeP Seepage Number ofPits....... al�U. ...'.`... ..Diameter?.��l.........Depth._.__..-�i Cesspool: Distance from nearest well..._.............Distance from foundation..............:.....Lining I y . ma+erial......_...._._-__._.____.______.__-__. Size: Diameter . ................ De th.--.._.-----_-_____----------:_ - Liquid Capacity gals. Privy:i Distance from nearest well.................................................Distance from nearest building..;-----------_--------.--_---_________-_. ❑ ••--- - Distance to nearest;lot-line-------- -.. __�_ ...................................................... I ti Remodeling and/or repairing (describe) -------_-------• --:----.._.._-•---• -•--•-----------•-=-----------------------•--------•---•----------- ------------------------------••-••----•-----•----•--•-•-•---•----------------•----••-----------------•-----------•------ :................._._.............................. t t f .........:............................ ..........................................----------------------.--------------------------------------------- r------------------•-----------•------•------------------•--------- I hereby certif f I haveprepared this application and that the work will,be done in accordance with San Joaquin County ordinances, State ws,` a d rules and regulations of the San Joaquin-Local Health District:' 1 (Signed ___________ ___ _ _.. .-• ----- ••---- (Ow r Contractor) i t -- (Plot plan, showing size of lot, location of.system in relation'to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY = -------- DAT --•--•== -------•------................................ BY i = ` - DATE �:-------- BUILDING PERMIT ISSUED.................. + DATE and/or.recommendations:.............. `.._:_.._..._..._._-__.----------,------.-_.._.____._...• ........_ ----------=------------------ ' ------------- ...................... .........---------------------...._.......-----------...-•-...._... ...._.sy .......' -.. ._.. -------•- --- ----•---- ------ ------------ .77 FINAL INSPECTION BY":* '..:- - —Date:...-.� ® ...- .---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California